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Is severe atherosclerosis in the aortoiliac region a contraindication for kidney transplantation?

Z Galazka1, T Grochowiecki, T Jakimowicz

  • 1Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland. zgalazka@amwaw.edu.pl

Transplantation Proceedings
|October 15, 2011
PubMed

Insights

Vascular reconstruction enables kidney transplantation in end-stage renal disease patients with severe atherosclerosis. This procedure addresses aortoiliac occlusive disease, allowing successful allografting and improving transplant eligibility.

Area of Science:

  • Vascular Surgery
  • Nephrology
  • Transplantation Medicine

Background:

  • Severe atherosclerosis is prevalent in end-stage renal disease (ESRD) patients on dialysis.
  • Aortoiliac occlusive disease was a contraindication for kidney transplantation but is now an extended indication.
  • These patients require pre-transplant vascular reconstruction.

Purpose of the Study:

  • To present the experience with vascular reconstruction prior to kidney transplantation in ESRD patients.
  • To evaluate the safety and efficacy of reconstructive procedures for enabling transplantation in complex cases.

Main Methods:

  • Twelve ESRD patients with severe aortoiliac occlusive disease were evaluated.
  • Preoperative imaging included Doppler ultrasound and angio computed tomography.
  • Vascular reconstruction utilized aorto-biliac, aorto-bifemoral, or ilio-femoral grafts under general anesthesia.

Main Results:

  • No major postoperative complications occurred; patients were discharged to a transplant waiting list.
  • Eight patients received kidney allografts, with arterial anastomosis to the vascular prosthesis.
  • No graft infections or major arterial complications were observed; four cases had delayed graft function.

Conclusions:

  • Vascular reconstruction is a viable option for ESRD patients with severe aortoiliac atherosclerosis.
  • This approach facilitates successful kidney transplantation, expanding eligibility criteria.
Abstract

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